Editor's Note: The convergence of innovation and knowledge flows through Shenzhen, a city in the Greater Bay Area. The "2024 Annual Meeting of the National Clinical Research Center for Infectious Diseases and the 15th Tuberculosis Eastern Forum," hosted by the Shenzhen National Clinical Research Center for Infectious Diseases and Shenzhen Third People's Hospital, took place from September 19 to 23, 2024. Under the theme "Technology for the People, A World Without TB," experts and scholars from across the country gathered to share cutting-edge advancements in TB prevention and control and practical experiences. Infectious Diseases Frontier had the opportunity to interview Dr. Shuihua Lu, Vice Director of the National Clinical Research Center for Infectious Diseases and Chairperson-Elect of the Tuberculosis Branch of the Chinese Medical Association. He shared highlights from the forum and insights on building "Tuberculosis-Free Cities."01
Infectious Diseases Frontier: Congratulations on the successful conclusion of the 15th Tuberculosis Eastern Forum! Could you introduce the history of the forum and the highlights of this year’s event?
Dr. Shuihua Lu: The Tuberculosis Eastern Forum began 15 years ago in Shanghai as an academic meeting. Over the years, it has focused on integrating basic research, clinical practice, and TB prevention strategies, especially emphasizing the role of basic research in driving clinical studies. This tradition has been key to the forum’s growth. Looking back, the forum has attracted numerous domestic and international experts, bringing together Eastern and Western scholars to exchange ideas. The forum has been held in cities like Shanghai, Suzhou, and Shenzhen, with each session seeing increased academic quality, scale, and depth of discussion. The number of participants has grown from around 100 in the early years to a peak of seven to eight hundred, reflecting the growing global attention to tuberculosis research.
This year’s conference, as always, invited renowned experts from various fields, including basic science, clinical practice, and public health. Speakers included prominent academicians such as Zihe Rao and Guoping Zhao from the Chinese Academy of Sciences, and Hongzhou Lu from the American Academy of Microbiology. We also had experts from international organizations like the World Health Organization (WHO) and the Bill & Melinda Gates Foundation. A key highlight of the conference was the interactive discussions, with thought-provoking questions, debates, and responses that not only enhanced learning but also helped clarify many of the challenges in TB prevention and control. These exchanges provide valuable insights for shaping national TB control measures.
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Infectious Diseases Frontier: You presented on the “Xtop (XP) Strategy” for creating “Tuberculosis-Free Cities.” Could you share more about the expansion from “Tuberculosis-Free Communities” to “Tuberculosis-Free Cities” and the innovative strategies involved?
Dr. Shuihua Lu: Despite progress, China remains one of the 30 high-burden TB countries globally. In 2022, there were an estimated 748,000 new TB cases in China, accounting for 7.1% of the global total. This represents a decrease from 780,000 in 2021, but China still ranks third worldwide. Over the past two decades, China has made considerable efforts in TB prevention and control, aligning closely with WHO strategies. Chinese medical professionals, public health workers, and scientists have made significant contributions to TB control, but there is still a gap between the outcomes and our expectations. This indicates a need for further improvement in TB control strategies, incorporating technological innovation to enhance efficiency.
In 2022, China’s CDC proposed the concept of “Tuberculosis-Free Communities,” aiming to reduce TB incidence to below 10 per 100,000 residents in specific areas such as towns, schools, military units, long-term care institutions, and large enterprises. More than 400 districts and counties nationwide are currently piloting “Tuberculosis-Free Communities,” with plans for nationwide expansion. In economically developed regions like Guangdong, Zhejiang, and Jiangsu, efforts have been made to extend this concept to “Tuberculosis-Free Cities.” For example, Shenzhen’s Nanshan District launched its “Tuberculosis-Free City” initiative in March 2024. This district, with a population of 1.8 million and a floating population of up to 3 million, faces the challenge of expanding TB control efforts from smaller-scale communities to larger urban populations. Guangdong’s newly established provincial CDC is also promoting pilot projects like “Tuberculosis-Free Counties” in areas such as Nanshan and Yingde. Zhejiang’s Huzhou has set even more ambitious goals, aiming to create a tuberculosis-free city with a population of up to 10 million.
Scientific management and technological innovation are key to building tuberculosis-free cities. The challenge is implementing TB control without excessive costs and complexity. We must rely on detailed planning, community engagement, and the development of affordable and effective technologies for TB control. For example, AI-powered diagnostic tools are showing great potential for reducing the manpower needed for chest X-ray interpretation and improving diagnostic accuracy. We are also working to lower the cost of nucleic acid testing to make it more accessible. During the COVID-19 pandemic, we successfully applied CRISPR technology for fast, accurate, and affordable TB detection. These innovations are instrumental in constructing tuberculosis-free communities and cities, and we believe that with scientific management and technological innovation, the creation of tuberculosis-free communities and cities will expand with greater success.
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Infectious Diseases Frontier: What challenges remain in eradicating tuberculosis, and how can we further advance the End TB strategy?
Dr. Shuihua Lu: China’s large population and vast geographical area, combined with significant regional disparities, present major challenges to TB control. Addressing these challenges using traditional public health strategies would require massive investments in manpower, resources, and funding. This underscores the need for innovative TB prevention and control technologies. Developing more accessible, affordable, and accurate screening and diagnostic tools is critical. Our AI diagnostic product has been included in the WHO’s global partnership’s recommended list for TB control, and our TB rapid detection products (such as the ESAT-6 and CFP-10 skin tests) have also been included in WHO guidelines. These technologies offer efficiency and accessibility, leading to their endorsement by WHO.
Although there have been breakthroughs in new TB treatments, the high costs prevent many patients from accessing advanced therapies. Our priority is to develop effective and affordable treatment options that can benefit the general population.
In the field of TB control, innovation requires continuous learning and a keen awareness of technological advancements. Despite the challenges, vaccine research remains a crucial area of focus. During this forum, we held a closed-door meeting on new TB vaccine development, discussing the challenges, opportunities, and future directions for TB vaccines. We hope China will make significant breakthroughs in this area and accelerate progress toward achieving the End TB goal.
